[Topical issues of adequate control of dyslipidemia in the prevention of acute and recurrent cerebral circulatory disorders of ischemic type]. / Aktual'nye voprosy adekvatnogo kontrolya dislipidemii v profilaktike ostrykh i povtornykh narushenii mozgovogo krovoobrashcheniya po ishemicheskomu tipu.

Ischemic stroke (IS) is one of the main causes of death and permanent disability. Reducing the burden of stroke is possible if effective preventive measures are provided. The possibilities of correcting lipid metabolism as an important measure aimed at preventing IS are analyzed.

[Russian Medical Society for Arterial Hypertension expert consensus. Resistant hypertension: detection and management].

The diagnosis of resistant arterial hypertension allows us to single out a separate group of patients in whom it is necessary to use special diagnostic methods and approaches to treatment. Elimination of reversible factors leading to the development of resistant arterial hypertension, such as non-adherence to therapy, inappropriate therapy, secondary forms of arterial hypertension, leads to an improvement in the patient's prognosis. Most patients with resistant hypertension should be evaluated to rule out primary aldosteronism, renal artery stenosis, chronic kidney disease, and obstructive sleep apnea. The algorithm for examining patients, recommendations for lifestyle changes and a step-by-step therapy plan can improve blood pressure control. It is optative to use the most simplified treatment regimen and long-acting combined drugs. For a separate category of patients, it is advisable to perform radiofrequency denervation of the renal arteries.

[Clinical characteristics and quality assessment of the treatment of patients with chronic heart failure with diabetes mellitus].

AIM: A study of the clinical and instrumental characteristics and quality of treatment of patients with chronic heart failure (CHF) with diabetes mellitus. MATERIALS AND METHODS: The study was conducted by using the CHF register method, which is a computer program with remote access, which allows on-line data collection on patients who have been examined and treated in primary care and in hospitals. The study included 8272 patients with CHF IIIV FC (functional class) (New York Heart Association NYHA); among them 62% of patients were treated in hospital. RESULTS: The study showed that the frequency of diabetes was 21%. The main causes of CHF in diabetic patients are coronary artery disease, myocardial infarction (in anamnesis) and hypertension. These patients are more often diagnosed with III and IV CHF FC according to (NYHA) and retained LV (left ventricular) ejection fraction. The reduced ejection fraction was observed in 6.8% of cases, and the frequency of the intermediate LV was significantly higher than among patients with CHF and with diabetes and accounted for 18.9%. At patients with CHF with diabetes in comparison with patients with CHF without diabetes, atherosclerosis of the peripheral arteries, stroke (in anamnesis) and chronic kidney disease of stage III and IV were significantly more common. CONCLUSION: Under the treatment, patients with CHF with diabetes have higher levels of SBP (systolic blood pressure), lipids and glucose in the blood plasma, indicating a lack of quality of treatment and, accordingly, the doctors are not optimally performing the clinical guidelines on treating this category of patients.

[Comparative capabilities of the speckle-tracking echocardiography technologiesin two-dimensional and three-dimensional modes in the detection of subclinical cardiotoxicity in patients with breast cancer].

AIM: The study was to assess the deformation properties of the left ventricle (LV) myocardium in patients with breast cancer initially and after anthracycline chemotherapy according to 2D and 3D speckle-tracking echocardiography (STE). MATERIAL AND METHODS: the study included 99 patients with triple negative breast cancer with hypertensionandnormotension. All patients underwent standard transthoracic echocardiography with assessment of systolic function of the LV. To assess the indicator of global longitudinal strain (GLS), as a marker of cardiotoxicity, STE was used in two-and three-dimensional modes. In the three-dimensional STE mode, a new strain parameter, the global area strain (GAS) was evaluated. RESULTS: The study showed that in patients with breast cancer for a more accurate assessment of LV systolic function (ejection fraction) it is advisable to use 3D-echocardiography. A comparative analysis revealed statistically significantly lower values of the GLS according to the three-dimensional mode of STE compared to two-dimensional. The study also evaluated a new strain parameter GAS (%). In patients with breast cancer during ROC analysis with a value of -14.0, the GAS indicator for the development of subclinical cardiotoxicity showed a sensitivity of 81.5% and a specificity of 73.3%. Сonclusion.the advantage of the STE in the three-dimensional mode, in contrast to the two-dimensional mode, is the simultaneous and more accurate assessment of LVEF. The value of the additional parameter of LV deformation the area of deformation requires further study.

Arterial hypertension and chronic obstructive pulmonary disease: clinical characteristics and treatment efficasy (according to the national register of arterial hypertension).

AIM: The objective of the research is studying of demographic and clinical profile as well as treatment effectiveness of patients with AH and COPD based on National Register of Arterial Hypertension. MATERIALS AND METHODS: Among the analyzed selection, consisted of 32 571 patients with AH, who were followed up in the primary medical care, at the average age of 64±7 years old (there were 64% women of them), 5.4% patients with AH had COPD. The analysis of cardiovascular and cerebrovascular diseases frequency as well as treatment effectiveness was made. RESULTS: According to National Register of Arterial Hypertension, cardiovascular [coronary heart disease, Q myocardial infarction, chronic heart failure (CHF), peripheral artery atherosclerosis] and cerebrovascular (stroke/transitory ischemic attack) diseases are accurately more often diagnosed at patients with AH and COPD. CONCLUSION: Male sex and age are the strongest independent factor, contributing into the risk of development of cardiovascular diseases at these patients. COPD considerably increases the risk of CHF development. The conducted analysis has shown that treatment, prescribed to patients with AH and COPD meets modern recommendations.

[Progress and Problems of Practical Cardiology in Russia at the Present Stage].

Mortality of the population due to diseases of the cardiovascular system is the most acute problem in Russia. According to the World Health Organization, the standardized death rate from cardiovascular diseases in the Russian Federation remains one of the highest in Europe. This review presents statistical data on morbidity and mortality from cardiovascular diseases in the Russian Federation and analyzes the delivery of medical care to patients with these diseases in 2017. Information about activity of primary vascular departments and regional vascular centers is given. The article suggests a set of measures aimed at improvement of the provision of medical care to patients with cardiovascular diseases.

Features of the clinics and treatment of patients with obesity and hypertension (according to the National register of arterial hypertension).

AIM: The purpose of this study lied in the examination of the clinical characteristics and assessment of the quality of treatment for patients with arterial hypertension (AH) with obesity according to the National Registry of the AH. MATERIALS AND METHODS: The frequency of obesity in a sample of patients with AH, observed in 2010-2016. in polyclinics and cardiological dispensaries for cardiovascular diseases (CVD), was 38.3%, of which the incidence of severe obesity (grade III) was 8%. Women account for the majority of obese AH patients (72%). RESULTS: The study revealed the burden of AH patients with obesity in the following risk factors for CVD: dyslipidemia, hyperglycemia and a history of early cardiovascular disease. Relatively often in patients with hypertension with obesity, there were lesions of target organs (hypertrophy of the left ventricle, chronic kidney disease of the third stage), CVD [ischemic heart disease (CHD), chronic heart failure (CHF) II-IV functional class NYHA] and diabetes mellitus type 2 These data indicate that patients with AH obesity refers to a high and very high cardiovascular risk. CONCLUSION: Conducted antihypertensive and hypolipidemic therapy (statins) in patients with AH obesity was not optimal, only 30% of patients achieved the target level of BP and 23.6% - the target level of total cholesterol.

The prevalence of abdominal obesity and the association with socioeconomic status in Regions of the Russian Federation, the results of the epidemiological study - ESSE-RF.

AIM: The aim of the study is to determine the prevalence of AO in the population and to assess the association with socioeconomic factors according to the data of the ESSE-RF study (Epidemiology of Cardiovascular diseases in the Regions of the Russian Federation). MATERIALS AND METHODS: The object of the study is a random population sample of men and women aged 25-64 years from 13 regions of the Russian Federation (n=21 817). Abdominal obesity in men was defined as waist circumference (WC) >94 cm, and in women - WC >80 cm. Body mass index (BMI) >30.0 kg/m2 was adopted as the criterion of common obesity. RESULTS: The prevalence of AO in Russia was 55% (61.8% in women and 44% in men), while the percent of people with obesity, defined by BMI was significantly lower (33.4%). The number of examined patients with AO increased with age among both men and women (p<0.0001). A person with AO more often were people with low and very low income and low education levels (p<0.0001). Direct association between employment status and family status and AO in present study did not find, but WC was statistically significantly important criterion among male workers in comparison with those who never worked (p<0.0001), young men and women married, as well as married men of older age groups (p<0.0001).

[Life Threatening Complications in Patients With ST-Elevation Acute Coronary Syndrome-Dependence on Reperfusion Interventions (Data of Federal Register of Patients With Acute Coronary Syndrome)].

AIM: to study rate and type of life-threatening complications (LC) in patients with ST-Elevation (STE) Acute Coronary Syndrome (ACS) and their relation to implementation of reperfusion measures. MATERIAL AND METHODS: Database of the Federal Register of patients with ACS (FRACS) which functioned from 01/01/2009 to 01/01/2014 contains information on 212304 patients with verified diagnosis of ACS. From this pool using random number generator we selected a cohort comprising 10348 patients with STEACS (60% men, mean age 63.5+/-0.1 clinical systolic and diastolic arterial pressure [AP] 135.2+/-0.3 and 81.9+/-0.2 mm Hg, respectively). Killip class was used for determination of degree of acute heart failure. RESULTS: Most frequent forms of LC were heart rhythm disturbances (6.2%) and cardiogenic shock (5.4%). Patients subjected to percutaneous coronary intervention (PCI) including those in whom pharmacoinvasive approach was used had less LC and lower hospital mortality than patients who received only thrombolytic therapy (TLT). Reperfusion measures were administered mostly to patients with class I-II acute heart failure. Hospital mortality was highest (9.47%) among patients not subjected to reperfusion measures and lowest (1.09%) among patients treated with PCI+TLT. CONCLUSION: FRACS assesses LC in patients with STEACS in the context of implemented reperfusion measures. Data of FRACS can be used by the health service authorities for improvement of medical aid to patients with STEACS.

[The First Results of the Russian Register of Chronic Heart Failure].

We present in this paper first results of the Russian registry of chronic heart failure (CHF) as well as comparative analysis of available registries and a number of randomized controlled trials and meta-analyses on CHF.

[Comorbidity of cardiovascular diseases and cancers: Problems in the diagnosis of cardiotoxic effects of chemo- and radiation therapy].

Cardiovascular diseases (CVD) and cancers are the leaders in their prevalence and the major causes of death in economically developed countries, determining their high sociomedical significance in society. Improvement of methods for the early diagnosis and treatment of cancers has contributed to increases in relapse-free survival and life expectancy in these patients. At the same time, the new problems have emerged particularly in the development of various cardiovascular events/diseases when treating cancer, which may predict worse prognosis in patients and be an independent cause of death. To search for new markers of cardiotoxicity at early stages and to develop effective methods for the prevention and personalized treatment of cancer and CVD are the problems that can be solved only by joint efforts of cardiologists and oncologists.

[Meta-analysis of clinical trials of cardiovascular effects of magnesium orotate].

AIM: To make a meta-analysis of clinical trials of magnerot (magnesium orotate) used in cardiac patients. SUBJECTS AND METHODS: The meta-analysis covered the data of 19 randomized trials including a total of 603 patients treated with magnerot (a case group) and 587 receiving placebo (a control group). The patients' mean age was 36 ± 19 years. On the average, the patients took magnerot 1878 ± 823 mg/day for 4.2 ± 29 months. RESULTS: Associations between the intake of magnerot and the risk of 50 pathological conditions were analyzed. Significant associations were established between the drug's administration and the reduced risk of conditions, such as hypomagnesemia (relative risk (RR) = 0.06; 95% confidence intervals (C): 0.04 to 0.09; p = 2 · 10(-46)), exercise intolerance (RR = 0.41; 95% CI: 0.27 to 0.62; p = 0.0004), dysautonomia (RR = 0.08; 95% CI: 0.04 to 0.14; p = 2 · 10(-21)), morning headache (RR = 0.16; 95% CI: 0.09 to 0.29; p = 1.5-10(-6)), tension headache (RR = 0.16; 95% Cl: 0.09 to 0.27; p = 5 · 10(-10)), dizziness (RR = 0.28; 95% CI: 0.15 to 0.50; p = 0.0004), first-degree mitral valve prolapse (MVP) (RR = 0.05; 95% CI: 0.03 to 0.09; p = 1.2 · 10(-25)), grade 1 regurgitation (RR = 0.29; 95 CI: 0.14 to 0.60; p = 0.0075), supraventricular (RR = 0.30; 95% CI: 0.21 to 0.44; p = 1 · 10(-8)) and ventricular (RR = 0.48; 95% CI: 0.30 to 0.76; p = 0.019) premature contraction, paroxysmal supraventricular tachycardia (RR = 0.28; 95% CI: 0.15 to 0.50; p = 0.0002), and hypertension (RR = 0.32; 95% CI: 0.17 to 0.58; p = 0.0027). CONCLUSION: The use of magnesium orotate is promising not only in treating MVP and compensating for hypomagnesemia, but also in preventing and treating cardiac arrhythmias, regulating blood pressure, and improving the function of the autonomic nervous system.

[Cystatin C and preclinical lesions in the target organs of hypertensive patients].

AIM: To study the association between cystatin C levels and preclinical lesions in the target organs (heart, kidney, vessels) of patients with hypertensive disease (HD) at moderate and high risks for cardiovascular events (CVE). SUBJECTS AND METHODS: The investigation enrolled 47 patents (30 men and 17 women) with Stages I-II HD at moderate (n = 23) and high (n = 24) risks for CVE. The patients' mean age was 46.0 ± 1.8 years; the duration of HD was 4.1 ± 0.2 years. The blood level of cystatin C was estimated by photometry using a biochemical autoanalyzer. Glomerular filtration rate (GFR) was calculated by the MDRD formula. Microalbuminuria (MAU) was determined by turbidimetry employing a biochemical autoanalyzer. RESULTS: No association between cystatin C level and 24-hour blood pressure (BP) monitoring readings was found in the patients except the men in whom it was correlated with 24-hour diastolic BP (DBP) (r = 0.36; p < 0.05). The hypertensive patients showed a positive correlation of cystatin C with their age (r = 0.51; p < 0.001). There were higher cystatin C levels in smoking patients with HD (n = 19) and no statistically significant differences in the level of MAU, urine uric acid, and GFR between them. There was a statistically highly significant negative. correlation between cystatin C concentration and GFR by the MDRD formula (r = -0.59; p < 0.001), at the same time, no correlation was found between creatinine clearance (by the Cockroft-Gault formula). There were no statistically significant differences in cystatin C levels in relation to the presence or absence of carotid atherosclerosis (1.01 ± 0.03 and 0.93 ± 0.02 mg/l, respectively; p = 0.08). Overall, there was a positive correlation of cystatin C levels with left ventricular mass index (r = 0.58; p < 0.001) and relative myocardial thickness index (r = 0.40; p < 0.05). CONCLUSION: The findings of the association of cystatin C and 24-hour DBP, preclinical lesions in the heart, vessels, and kidney seem to argue for the concept of cardiorenal syndrome in patients with HD just at its early stages.

[Perspectives of application of evidence-based measures of blood pressure control in patients with arterial hypertension].

AIM: of the study was to assess advantages and disadvantages of existing measures of adequacy blood pressure (BP) control and their appropriateness in Russian population of patients with arterial hypertension (AH). MATERIAL AND METHODS: Two indicators were studied with the help of American College of Cardiology/American Heart Association methodology (ACC/AHA, 2005): Russian AH registry indicator "Achieving and maintenance of the goal BP" and indicator "Optimal AH treatment" adopted from UK and US measures for the data of Russian AH registry. Each indicator was calculated in the same group comprising 37 827 patients with diagnosis AH. The data from the year 2011 were used. RESULTS: Indicator "Achieving and maintenance of the goal BP" was evaluated in 27% of eligible patients. Extrapolation to the total study group showed that portion patients with goal BP was 17.5%. Indicator "Optimal AH treatment" was evaluated in 47.5% of its target group. Extrapolation to the total study group showed that portion of optimally treated patients was 42.4%. Analysis with the help of ACC/AHA methodology demonstrated feasibility of using both indicators for assessment of degree of BP control among Russian AH patients. According to its characteristics indicator "Optimal AH treatment" was found appropriate for monitoring the effectiveness of AH treatment on popular level. Use of indicator "Achieving and maintenance of the goal BP" in the system of interrelated quality measures was considered to be appropriate for audit of completeness of implementation of recommended treatments in medical care delivered to AH patients. CONCLUSION: Measures of adequacy of BP control being realized in Russia and abroad allow to characterize reliably the effectiveness of treatment among Russian AH patients and may be implemented on different organizational levels of healthcare system for monitoring of clinical situation in population as well as for audit of work of healthcare units.

[Creation of a Russian Federation's register for assessing the physician adherence to the guidelines for the diagnosis and treatment of chronic heart failure].

The paper reviews existing chronic heart failure (CHF) registers, a number of randomized trials, and meta-analyses on CHF. It provides a rationale for the need to create a CHF register in the Russian Federation, which will be able to assess the physician adherence to the guidelines for the guidelines for and the quality of medical care.

[The prevalence of anxiety and depression in different regions of the Russian Federation and its association with sociodemographic factors (according to the data of the ESSE-RF study)].

AIM: To study the prevalence of anxiety and depression by psychometric methods (the Hospital Anxiety and Depression Scale (HADS) in different regions of the Russian Federation (RF), which are characterized by various climatic, geographic, economic, and demographic indicators. SUBJECTS AND METHODS: The investigation used the data of the multicenter epidemiological survey of cardiovascular diseases in different regions of the Russian Federation--the ESSE-RF study. The subjects of the study were representative samples from unorganized male and female populations aged 25-64 years from 10 RF regions. The survey included a total 16,877 people (6244 men and 10,623 women). All the examinees were interviewed using a standard questionnaire. An analysis involved their gender, age, education level, place and region of residence, and income and morbidity level. The HADS validated in Russia was used to rate the level of anxiety/depression. RESULTS: The total prevalence of higher anxiety and depression averaged 46.3 and 25.6%, respectively. Respondents with clinical anxiety/depression constituted more than one third of those who had a higher level of these conditions. In the examined population, the moderate level of anxiety/depression was 7.5 ± 0.06 and 5.1 ± 0.04, respectively. The population of Volgograd, Samara, Saint Petersburg, and Tomsk had the similar values of the moderate level of anxiety/depression (p > 0.05). The lowest level of anxiety/ depression (p < 0.0001) was seen in the dwellers of Tyumen (5.9 ± 0.1 and 3.4 ± 0.1, respectively) and the highest in the Republic of North Ossetia-Alania (NOA) (8.4 ± 0.1 and 6.8 ± 0.1, respectively). These regions showed the lowest and highest prevalence of higher anxiety (22% in Tyumen and 59.8% in the Republic of NOA (p < 0.0001). CONCLUSION: All the 10 selected RF regions differing in demographic, economic, climatic, and geographical parameters are characterized by a high level of anxiety that remains statistically significant after adjusting for gender and age, so are parameters, such as income and morbidity levels are present in only 4 of the 10 regions.

[Prevalence of cardiiovascular risk factors in Russian population of patients with arterial hypertension].

We studied prevalence of arterial hypertension (AH) and its association with major cardiovascular (CV) risk factors among unorganized adult population aged 25-64 years in 10 Russian cities (Volgograd, Voronezh, Ivanovo, Irkutsk, Krasnoyarsk, Orenburg, Vladikavkaz, Samara, Tomsk, Tyumen) with different climatic, geographical, economical and demographical characteristics. This cross-sectional epidemiological study was conducted within the framework of the ESSAY RF-2012 (Epidemiology of Cardiovascular diseases in the Regions of the Russian Federation) project. Epidemiological situation concerning AH was found to be unfavorable. Prevalence of CV risk factors was high especially in young men and postmenopausal women. Major CV risk factors, associated with AH were hypertriglyceridemia, hyperglycemia, and obesity. The obtained results substantiate the expediency of the use of population strategy of AH and CV risk factors prevention in the studied population.

[Is there an association of uric acid level with preclinical target organ damage in moderate- and high-risk hypertensive patients?].

AIM: To assess an association of uric acid level with preclinical target organ damage in patients with hypertensive disease (HD). SUBJECTS AND METHODS: The trial enrolled 100 patients (63 men and 37 women) with Stage I-II HD at moderate and high risk for cardiovascular events (CVEs). The mean age of the patients was 44.9 +/- 1.3 years. Their medical history showed that the duration of hypertension averaged 4.4 +/- 0.3 years. The average daily level of systolic blood pressure (BP) was 138.1 +/- 1.4 mm Hg and that of diastolic BP was 84.3 +/- 1.1 mm Hg. RESULTS: The entire patient group showed a positive correlation between C-reactive protein (CRP) and serum uric acid (SUA) (r = 0.27; p < 0.01), suggesting that the nonspecific inflammatory processes were associated with uric acid levels in patients with HD. An intragroup analysis also revealed a relationship between CRP and SUA levels in the hypertensive patients at high risk for CVEs (r = 0.43; p = 0.01); this relationship was not found in those at their low risk. The hypertensive patients were ascertained to have elevated CRP levels and microalbuminuria, hyperuricosuria, and glomerular hyperfiltration when they had a SUA level >319 micromol/l. CONCLUSION: It can be assumed that the SUA level >319 micromol/l triggers the activation of nonspecific inflammatory processes, which in turn affects renal microvessels.

[Vasomotor endothelial dysfunction in young men with grade 1 arterial hypertension].

In order to study vasomotor endothelial function and risk factors of endothelial dysfunction in young men with grade 1 arterial hypertension (G1AH) we examined 76 men with G1AH and 30 healthy men aged 20-40 years. Flow-mediated vasodilatation (FMD) of the brachial artery was assessed by ultrasonic method of Celermajer D.S. Vasomotor endothelial dysfunction (FMD<6%) was found significantly more frequently in men with G1AH than in healthy men (51% vs 13%). In healthy young men with normal blood pressure smoking was the main risk factor of endothelial dysfunction. In young men with G1AH risk factors for endothelial dysfunction were: family history of early cardiovascular disease, smoking, and elevation of low-density cholesterol level. Probability of endothelial dysfunction in the absence of these factors was low - 11%, in the presence of one factor it was 30%, two factors - 60%, and three factors - 83%. Elevated (>14.8%) red blood cell distribution width (RDW) was associated with endothelial dysfunction. Probability of endothelial dysfunction in young men with G1AH and elevated RDW was 5 times greater than in those with normal RDW.

[Results of the Federal (National) Project for prevention and treatment essential hypertension patients in Russia from 2002-2012 years].

The analysis of measures efficiency for prevention by essential hypertension (EH) in Russian Federation within the space of 2002-2012 years was realized. Those measures were carrying out Federal (National) Project and primary activity of the medical and scientific institutions under the leadership Russian Cardiology Research and Production Complex. The basic result was decrease in cardiovascular disease death rate starting with 2004 year The most pronounced significant changes were found in death rate from the cerebrovascular diseases. From 2003 to 2012, the annual cerebrovascular disease death rate decreased in 1,5 times (in 2003 - 339,9 by 100 thousands, to compare with 2012 - 224,1 by 100 thousands). Moreover, in 2012 thefatal stroke death rate was decreased on 114,8 thousands (to compare with 2004). Decrease of cardiovascular disease death rate is achieved from: early revealing of essential hypertension pts; development and introduction in practical public health of new methods of prevention ("Schools of Health"), adequate diagnostic and treatment of essential hypertension patients; increase of an educational level by cardiology in polyclinics, also use by the government of special purposes for Cardiovascular disease death rate decrease.